Use of vaginal hysterectomy in Denmark: Rates, indications and patient characteristics

Objective. To describe the use of vaginal, abdominal and laparoscopic hysterectomy in Denmark from 1999 to 2008, the influence of national guidelines and the patient and procedure-related characteristics associated with the choice of vaginal hysterectomy. Design. Nationwide register-based cohort study. Setting. Danish Hysterectomy Database and Danish National Patient Registry. Population. All women with a hysterectomy for benign indications in Denmark from 1999 to 2008. Methods. The incidence rate/100 000 women was used to describe the route of surgery in hysterectomies of 50 755 women. A multiple logistic regression analysis was done to examine the association between patient- and procedure-related characteristics and choice of surgical procedure including 20 486 women. Main outcome measures. Trends in surgical approach from 1999 to 2008. Patient- and surgery-related characteristics associated with vaginal hysterectomy from 2004 to 2008. Results. There was an overall increase in the use of vaginal hysterectomies from 12 to 34%, a decrease in the use of abdominal hysterectomies and a consistent number of laparoscopic hysterectomies. The number of vaginal hysterectomies varied between regions, ranging from 2 to 86%. The use of vaginal hysterectomy was not dependent on the total number of hysterectomies performed at the hospital. The characteristics associated with vaginal hysterectomy were higher age, smaller uterus size, indications for surgery (genital prolapse and severe uterine bleeding), less smoking and moderate alcohol intake. Conclusions: Vaginal hysterectomy has replaced abdominal hysterectomy increasingly but cannot be directly correlated to the implementation of national guidelines as there was large national variation. Several characteristics are significantly associated with vaginal hysterectomy.